Second Opinions Improving Healthcare Outcomes and Reducing Costs

December 15, 2020 by Amanda Raitz Hébert

Jeff’s heart sank when his doctor told him that he had an uncommon colon cancer called high-grade neuroendocrine carcinoma. It had already spread from his colon to both lobes of his liver, and the prognosis was poor. Even with aggressive treatment, the average life expectancy was only 12 months. 

Though Jeff and his wife were being treated at a well-known university hospital, his doctor’s first words on entering the room were, “We almost never see this; 99 percent of the colon cancer we treat is adenocarcinoma.” Jeff’s doctor followed the standard treatment protocol, but it didn’t reduce the size of the metastases in his liver.

Medical Misdiagnosis is Prevalent and Dangerous

We will all likely experience a meaningful medical misdiagnosis in our lifetime, as published in “Improving Diagnosis in Health Care,” and according to 2020 data from the American Cancer Society one in three of us will get cancer in our lifetimes. 

A misdiagnosis includes both the failure to accurately and timely diagnose a patient and failing to adequately communicate that diagnosis to the patient to enable that patient to make an informed decision about their healthcare. Misdiagnosis also includes overdiagnosis in which patients receive overtreatment that is potentially dangerous.

The stakes of medical misdiagnosis are not trivial. Almost 30% of misdiagnoses are life threatening or result in death or permanent disability. Altogether, medical diagnosis errors kill over 40,000 people per year in the US. Cancers are significant among the misdiagnosed diseases with up to 44% of cancers being misdiagnosed in the United States.

Diagnostic errors are most often caused by:

1.Poor communication between physicians, patients and their families.

2.A healthcare system workflow that is not properly designed to support the diagnostic process.

3.A healthcare culture that discourages transparency and the disclosure of diagnostic errors.

Second Opinion Programs Can Meaningfully Reduce the Health Impact of Misdiagnosis

Second opinions are one of the most powerful tools available for reducing diagnostic error. 

A study on second opinions published in Mayo Clinic Proceedings revealed that up to 88% of second opinions for serious medical conditions resulted in major changes to the diagnosis or recommended treatment plan. After receiving a second opinion, even one that confirms the initial diagnosis, most patients believe the second opinion to be valuable.

But second opinions only generally reduce diagnostic error if they are of equal or better quality than the first diagnosis. To receive at least an equal quality diagnosis, patients must receive a second opinion from a high quality academic medical center.

Second Opinions Can Potentially Reduce the High Healthcare Cost of Misdiagnosis and Overtreatment

Healthcare utilization from misdiagnosis, overtreatment and fraud in private insurance is estimated to account for up to 30% of private healthcare expenditures, or $422 billion in 2011; cited in JAMA “Eliminating Waste in US Healthcare.”

This cost is covered by insurance premiums and patient out of pocket expenses.

As second opinion programs continue to be researched, the most comprehensive study to date has shown that for each $1.00 spent on second opinion programs, medical costs are reduced by $2.63. This makes second opinion programs a cost-saving must for all self-insured companies and a sensible option for all plans. 

A Second Opinion for Liver Cancer

Jeff was able to access a second opinion from the world’s leading expert in high-grade neuroendocrine carcinoma at one of America’s top 10 hospitals. The Physician Specialist recommended new scans which could find every neuroendocrine cancer cell in his body and help produce a targeted treatment plan. The physician specialist also provided detailed advice on how to access the latest treatments for his specific condition. None of this had been mentioned by Jeff’s doctor. 

“The successful treatment of any major health condition relies on an unbiased team-based approach that brings multiple perspectives to the diagnosis of and treatment planning for each unique patient,” says Dr. Robert Warren, co-founder of MORE Health, and Professor of Surgery and Director of the Surgical Oncology Lab at UCSF Medical Center. “No physician can adequately treat a patient without help.”

Including Second Opinion Benefits in Plans

Second opinion services can be included in a benefit plan for very low costs. The benefit is only a fraction of the price of broader telemedicine consultation benefits, and the low per-employee-per-month cost allows the broker community to provide a desirable value-added benefit for their clients. Services provide employees with exclusive access to physicians at the world’s top ranked hospitals even when they are part of narrow networks or otherwise unable to get in to see top physicians. 

For more information on cost containment for self-insured groups, click here to view downloadable brochure that includes case study, or request a demo from our sales team today.

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